The Plight of Dementia care in India

India is home to more than 100 million people aged above 60 years, accounting for 8.6% of
the global geriatric population). A sharp increase in the number is expected in the coming
decades. Fast paced social changes along with demographic transition cause serious
challenges in addressing the concerns of elderly population. Declined social rights, lack of
infrastructure and support system, changing family structure and abuse further worsen the
scenario.

As the ageing population in India is on a steady incline, chronic diseases and disorders have
become an important public health concern in India. According to The Dementia in India
2020 Report, India is home to around 5 million people with dementia. This number is
expected to double by the end of next decade. This may pose a Substantial challenge to
society and to the Government. Still, It is not given due importance in the health policy or
programs. Only 1.2 % of the Indian GDP is allocated to health care. This is much lower than
what many other developing and developed countries spend on health care. Out of the 1.2 %,
only a tiny fraction is allocated to mental health and it is further reduced when it comes to
illnesses that affect the elderly.

Dementia and its Prevalence

Dementia is a health issue mostly found among geriatric population characterized by a

progressive deterioration in cognition including memory, learning, orientation, language,
comprehension and judgement due to disease of the brain. However, it is not a normal part of
ageing. Some researchers point at the gender predilection in dementia. Two thirds of persons
with dementia are women. However, Dementia India Report (2010) argues that dementia is
not having a gender predilection as there is no substantial difference in the age-specific
incidence of dementia between men and women. A possible explanation of the higher
prevalence of dementia among females could be explained by their higher life expectancy
when compared to the male counterpart. Nevertheless, it is noted that, at the older age, among
women, age specific prevalence of dementia is higher.

DEMENTIA CARE IN INDIA

Even though there is a growing recognition of dementia as a significant health problem in

India, apart from the NGOs and private services, dementia care remains limited in tertiary
care settings. The lack of awareness programs contributes to the late detection of the disorder
and hence the cases remain under-reported or not diagnosed. In India, memory loss is
considered normal and as a part of ageing rather than treating it as a degenerative disorder.
Also, lack of professional health care services and trained human resources along with lack of
prioritizing dementia as a public health concern aggravate the situation further (Dementia
India Report, 2010). The National mental health act 2017 acknowledges a huge unmet need
for caregivers in geriatric mental health. The care gap for dementia is almost 90%, where
only one among ten persons receives diagnosis or treatment.

In the Indian Scenario, it is the responsibility of the family and immediate family networks to
provide care and support for elderly persons. Of late, the family structure is going through
structural changes that affect the care of the elderly population. The care of People living
with Dementia (PLWD) is expensive and time-intensive. There is a gap in the information on
the economic costs and social burden of dementia in Indian society as expenses are mostly
met by individuals and families unlike in western countries. financial back up. ional for
quality dementia care (Scoping dementia and public health data, 2019).

Drawbacks of current system:

Currently, the need for Dementia care is partially addressed by the Government of India
through the National Program for Health Care of Elderly and the National Mental Health
Program. Dementia clinics mostly exist on an Out-patient basis, in tertiary care settings only.
NGOs like Alzheimer’s and Related Disorders Society of India, HelpAge India, Agewell
foundation are providing community based and home-based care for PLWD. They either act
their own or in partnership with the state Governments. These NGOs operate dementia
support clinics day-care centers, residential care centres and domiciliary services. Also, the
Indian Academy Neurology set up a cognitive neurology subsection with an aim to promote
knowledge and awareness on diseases such as Alzheimer’s and dementia. However, the
existing mechanisms to address dementia are highly fragmented and inadequate. Lack of
dementia services at the primary level makes it difficult for identifying dementia cases that
are distributed in the population. Also, the treatment services exist in isolation; hence
accessibility is very low. The referral pathways to guide a patient to a geriatric mental health
facility, is not established.

CONCLUDING REMARKS
India has the second-highest number of people living with dementia in the world numbering
around 5 million as of 2020. Considering the demographic transition, the number is estimated
to rise up to 7.3 million in the next four years, which is quite alarming.

Hence a holistic approach is necessary to address the situation. There is a need for a
comprehensive dementia policy that looks into the health care, early detection, legal services,
rehabilitation, palliative care, awareness generation among health workers, Geriatric care
providers and the public.

Any health program to be formulated in future should focus on strengthening community

networks and resources. A multi sectoral approach integrating clinical psychology,
neurology, sociology, and palliative care will be necessary in order to address this Plight.

Bibliography :

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Elderly. Ministry of Health & Family Welfare.

2. ARDSI. (2020). Dementia India Strategy Report. ARDSI.

3. Kallumpuram,S,V., Kumar,C,T. (2019). Dementia in India Report 2020:Dementia

Prevalance in India-Estimating the numbers. Cochin: Alzheimer's and Related
Disorders Society of India.

4. Kishor,S.(2015). Dementia India 2015 infographic. Dementia Care Notes.

5. Krishnamoorthy,E,S., Misra, V., Srivatsa,V,G. (2014). Dementia in India. in Wadia
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